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HomeMy WebLinkAbout2500 WIBLE ROAD (5)ca From: Franzen -Hill Inc. To: 16618522171 Page: 3/8 Date: 4/25/2011 12:58:14 PM MONITORING SYSTEM CERTIFICATION For Use By AllJurlsdletions Within the State ofCalifornia Authority Cited: Chapter 6 7, health and Safery Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form mttst be used to document testing and servicing of monitoring equipment. A Wale cettiftealtion or renort must be pronarcd far each monitoring system wntml Panel by the technician who performs the worts A copy of this firm must be provided to the tank system uwner /operator. The owner /operator must submit o copy ofthis form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: jni'4 . P , - Site Address: Gel C5.tlblc lecj_ City: Facility Contact Person: G1/741! Make/Model ofMonitoring System: C,S B. Inventory of Equipment Tested /Certified Churl, 0h noo.nn ;: hn 1n Ind1 —t. I.. sal ...I.,.. d I..a..a.. rau 1 ad. Bldg. No.: Zip: Contact Phone No.: ( Date ofTesting/Servicing: Tank ID: Tank lA: 11 In -Tank Gauging Probe. Model: G to -Tank Gauging Probe. Model: A ti 45,Annular Space or Vault Sensor. Model: ZG Arnlular Space or Vault Senior. Model: 10 Piping Sump / Trench Sensor(s). Model: M Piping Sump / Trench Sonsor(s). Model: CC:CI apritl Sump Sonsor(s). Model: Z. IS Fill Sump Sonsor(s). Model: 7.4e? Mechanical Une LeakDetector. Model: Q Mechanical Line Leak Detector. Model: L° Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank OvcrMl I Fllgh -Level Sensor. Model- 14, {l,l X11_ Tank Overfill I High -Level Sensor. Model: /tS Py& l 0 Other (specify equipment type and model in Section E onPage 2). 0 Other (specify equipment type and model in Section Eon Page 2). Tank ID: Tank ID: ' t — 0 In-Tank Gauging Probe. Model: In -Tank Gauging Probe. Modul: RAJ 0 Annular Space or Veuh Sensor. Model: Annular Space or Vault Sensor. Model: 0 Piping Sump /'Bench Sonsor(s). Model: Piping Sump / Trench SensWs). Model: ` 0 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: 0 Mechanical Line Leak Detector. Model: Mechanical Lim Leak Detector. Model: 0 Electronic Litre Leak Detector. Model: Electronic Line Leak Detector. Model. 0 Tank Overfill /Iligh Level Sensor. Model: 49Tank Overfill / Ifigh -Level Senior. Model: At IeL6 Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section Eon Page2). Dispenser YD: Dispenser ID: IODispensm Container rt Sens*s). Model: 0 Dispenser Contailumnt Sensoi(s). Model: OM Shear Valve(s), Q Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Contaim»eall Ploat(s) and Chain(s). Dispenser ID: 3 t Dispenser ID: WDispenser Co"talnmela Sonsor(s). Model: f1k S^rdtVh ,5i-QNk_ 0 Dispenser Contaimnent Sensor(s). Model: 91 Shear Valve(s). 0 show Valve(s). 0 Dispenser Containment Float(s) and Chain(s), 0 DispenserContainment Float(a) and Chain(a), Dispenser II): 4A1P Dispenser ID: Dispenser Contai ent Sonsor(s). Model: r G 0 Dispenser Containment Sonsor(s). Model: Shear Valve(s). 0 Shear Valve(s). 0 Dispenser Containment float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). 411 the laci lily contains more tanks or dispensers, copy this lorm. Include information for every tank and dispenser at the laciltty. C. Certification - I certify that the equipment identified in this document was inspected /serviced is accordance with the manufacturers' guideliues. Attached to this Cortifieatioo Is Information (e.g. manufacturers' checklists) necessary to verify that this information is correct and n Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, 1 have also attached a copy of the report; (check allthat apply): System set-up Ala history report Technician Name (print): % jam l Signature: 9 Certification No.: License. No.: [/, C47` Testing Company Name:.. Phone No.: Testing Company Address:1tL,t -G C4 Date ofTesringJServieing: Page 1 of 4 UN- W6 -114 www.aoldomorg This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com Rev, 01/17/09 From: Franzen -Hill Inc. Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: C.mmnlete the followlrrrz checklist: To: 16618522171 Page: 418 Date: 4/25/2011 12:58:14 PM IM Yes NO is the audible alarm operational? Yes No* Is the visual alarm operational? 10 Yes No* Were all sensors visually inspected, functionally tested, and conCmted operational? ail Yes p No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) N/A operational? CO Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment El N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? Ifyes: which sensors initiate positive shut -down? (Checkall that apply) )P Sump7J'rench Sensors; Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks aAn sensor failure/disconnection? *Yes; No. it Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at he tank fill int(s ) and operating properly? Jfso, at what percent oftank capacity does the alarm trigger? 476 % Yes* No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If es, describe causes in Section E, below. IS Yes No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable Yes 0 No* Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: S P 0, C.' fj Page 2 of 4 IJN- 036 — 214 www.unidomorg This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com Rev.o1117PA From: Franzen -Hill Inc. To: 16618522171 Page: 5/8 Date: 4/25/2011 12:58:15 PM Monitoring System Certification , R In -Tank Gauging / SIR .Equipment: Check this box iftank gauging is used only for inventory control. Check this box ifno tank gauging or SIR equipment is installed. This section trust be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes No" Was accuracy of system product level readings tested? Yes No* Was accuracy of system water level readings tested? Yes No Were all probes reinstalled properly'? Yes No* Were all items on the equipment manufacturer's maintenance checklist completed'? In Section hl, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Check this box if LLDs are not installed. Cnmmi -te. tha fntlawinv rherldtste Yes No* For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? N/A Check all Char apply) Simulated leak rate: UIP3 g.p.h.; [10.1 g.p.h ; 0 0.2 g.p.h. Yes No" Were all LLDs confinned operational and accurate within regulatory requirements? 12 Yes L1 No* Was the testing apparatus properly calibrated? Jb Yes Noy` For mechanical LLDs, does the LLD restrict product flow If it detects a leak? NIA Yes Q No* For electronic LLDs, does the turbine automatically shut offif the LLD detects a leak? 09 N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled 0 N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system it N/A malfunctions or fails a test? Yes 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected? r N/A o Yes No Were all items on the equipment manufacturer's maintenance checklist completed? In Section H, below, describe how and when these deficiencies were or will be corrected. A. Comments: Page 3 of 4 UN -036 — 3A www.umldomorg C This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /vwwv.gfi.com Rev. OV17MS 0 From: Franzen -Hill Inc. To: 16618522171 Page: 6/8 Date: 4/25/2011 12:58:15 PM Monitoring System Certification , UST Monitoring Site_ (Plan JSiteAddress: ( ") (hip ACC-- - —R -, f_'Vr5- ) G'P'I Date map was drawn: _/ 7, Z / // _. Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tack liquid level probes (ifused for leak detection). In the space provided, note the date this Site Plan was prepared. Page 4 of 4 UN -036 -- 414 www.anMlomorg Rev. 01 /17/08 This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com From: Franzen -Hill Inc. To: 16618522171 Page: 7/8 Date: 4/25/2011 12:58:15 PM SWRCB, January 2006 Spill Bucket Testing Report Form This form is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform and printoutsfrom tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY iNFORMATTON Facility Name: i Date of Testing: Facility Address: l ( Facility Contact: t Phone: " Date Local Agency Was No fled ofTesting : Name ofLocal Agency inspector (fpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Franzen -Hill Technician Conducting Test: Adam Taylor Credentials: X CSLB Contractor X 1CC Service Tech. © SWRCB Tank Tester 0 Other (Specify) License Number(s): Veeder Root B38383 /tncon 3387333701 — 5311578 -UT 3_ RPH,L RIICKF.T TFAMNG INFORMATION Test Method Used: X hydrostatic 0 Vacuum 0 Other Test Equipment Used: Equipment Resolution: .01 Identify Spill Bucket (lay Tank Number, Stored Product, etc, I F7. 2 I 3 4 Bucket installation Type: irect Bury D Contained in Sump Direct Bury 0 Contained in Sump_ Direct Bury 0 Contained in Sump n Direct Bury 0 Contained in Sum Bucket Diameter: 2 L Bucket Depth: Wait time between applying vacuum/water and start oftest: Test Start Time (Ti): a initial Reading (R,): Pest End Time (Tf,): Final Reading (Rf): G C r1 Fr Pest Duration (Tv — Tj): Ilk Change in Reading (Rf - Ri): Pass /Fail Threshold or Criteria: Tgst Result: Pass 0 Fall jg Pass D Fail Pass n Fail 0 Pass 0 Fail Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) CERTIFICATION OF TECIiNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report Is tru accurate, and In fall compliance with legal requirements. Technician's Signature: Adam Taylor Dater " State laws and regulations do not currently require testing o be performed by a qualified contractor, However, local requirements mveer ho. IY1nrP. ctrinaPnt This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com From: Franzen -Hill Inc. To: 16618522171 Page: 8/8 Date: 4/25/2011 12:58:16 PM Franzen -Hill Construction, Maintenance & Testing for Fueling Facilities & Lubricating Systems California Licensed Contractor No. 304147 900 -BSS -3436 SOURCE TEST RESULTS LEAK DETECTOR TEST pp e of Leak Detectors Tested (chock one Testing Company: RANZEN -HILL CORPORATION 1100 North J. Street Tulare, CA 93274 W.0 ft Service Order # XLD PIN 116036 -5 XLP PIN 116035 -5 BFLD (XL Model) P/N 116039 -5 DLD PIN 111J6017 -5 PLD PIN 116030 -5 BFLD PIN 116012 -5 TI.1ER C PRODUCT SERIAL # RESILIENCY NSN9 f4962 Test Conducted By: Adam Taylor Signature: C Technician # (VMI) 2495 TIME TEST LEAK METERING RESULTS OPEN RATE PSI GPH s s 4Q s Date: This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com From: Franzen-Hill Inc. To: 16618522171 Page: 1/8 Date: 4/2512011 12:58:13 PIVI 4 r s % -- To: FVV: Send data from e2830c 04/25/2011 12:58 From: Message: --Original Message--- - From: Franzen Hill- Copier [mailto:oopier@franzenhill.com] Sent: Monday, April 25, 2011 1:58 PM To: Clara Thurman Subject: Send data from e2830c 04/25/2011 12:58 Scanned from e2830c. Date: 04/26/2011 12:58 Pages:7 Resolution:300x300 DPI Franzen-Hill Inc. 1100 N. J St, Tulare, CA 93274 Tel: 559-688-2977 Fax: 559-688-1467 Website: http:/twww.franzenhill.com This fax was sent with GFI FAXmaker fax server. For more information, visit: hftp://www.gfi.com From: Franzen -Hill Inc. To: 16618522171 Page: 2/8 Date: 4/25/2011 12:58:14 PM Letter of Transmittal Franzen -Hill Corporation 1100 North J. Street Tulare, CA 93274 Phone: (559) 688 -2977 ext. 3002 Fax: (559) 688 -1467 1- 800 - 655 -3436 Email: cthurmanWranzenhill.com Organization: City of Bakersfield Name: Fax: 661 - 852 -2171 Phone: From: Clara Thurman Date: 4 /25/11. Subject: Test Results Pages: 7- Including Cover Comments: Please find the attached test results for the following site: Market Express 2500 Wible Road Bakersfield, CA If you should have any questions or comments please call (559) 688 -2977, ext. 3027 Respectfully, Clara Thurman Testing Coordinator This fax was sent with GFI FAXmaker fax server. For more information, visit: http: / /www.gfi.com